The impact of COVID-19 on waiting periods for total hip and total knee arthroplasty at a tertiary hospital in South Africa

The high prevalence of osteoarthritis drives significant demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA) in South Africa. The coronavirus disease 2019 (COVID-19) pandemic disrupted elective surgeries, leading to substantial surgical backlogs necessitating patient prioritisation to ensure timely intervention for those with severe disease. This study aimed to evaluate patient baseline characteristics and assess the impact of COVID-19 on waiting periods for THA and TKA at a South African hospital. This retrospective study (2015–2022) analysed patient demographics and waiting periods at a tertiary hospital in Durban, Kwazulu-Natal, South Africa. Demographic data collected included age, race, sex, employment status, diagnoses, disease severity (via Tönnis and Kellgren-Lawrence classifications), functional impact, and surgical dates. Pre and post COVID-19 waiting periods were assessed and compared. Statistical comparisons used Mann-Whitney U tests for continuous variables and chi-square tests for categorical variables (p < 0.05). Of 2500 screened patients, 870 were eligible (481 pre-COVID-19, 389 post-COVID-19). Median waiting times increased from 327 days pre-COVID-19 to 620 days post-COVID-19 (p < 0.001). Only 9.0 % of procedures were prioritized, with inconsistent use of severity classifications, despite high bilateral disease prevalence (53.6 %) and severe functional limitations (74.2 % of patients using assistive ambulatory devices). The near-doubling of waiting times post-COVID-19 highlights the need for prioritisation strategies. Integrating severity classifications with socioeconomic factors, into the Medically Necessary, Time-Sensitive (MeNTS) score can optimize resource allocation, reduce backlogs, improve patient outcomes and quality of life in South Africa's resource-constrained public health sector.